I'm a little confused on this chart:

CONSCIOUS SEDATION: 1 mg Versed and 200 mcg of Fentanyl given IV

Contrast was injected intravenously for opacifying the collecting system. The collecting system on the right side was not well visualized. A calculus however was noted. A ureteral stent as also noted. Under 2% lidocaine, aseptic precautions and fluoroscopic guidance, antegrade pyelogram was done through posterior approach with 22 gauge Chiba needle which showed a calculus in the inferior calix. Through posterolateral approach under 2% lidocaine and aseptic precaution, the inferior calix was punctured with a 22 gauge Chiba needle and a .018 guidewire was placed. With the aide of a Kumpe catheter, the ureter was catheterized and the Kumpe catheter was advanced into the distal ureter and the catheter was sutured to the skin with O-Silk. The procedure was done to serve as an access for percutaneous nephrolithotomy by Dr. X.

Percutaneous nephrostomy done through inferior calix and 5 French Kumpe catheter placed in the distal ureter to serve as an access for percutaneous nephrolithotomy.

Same patient, same physician, a few hours later:


With patient under general anesthesia, and under asceptic precaution, contrast was injected through the previously placed Kumpe catheter which was noted to be within the ureter. The Kumpe catheter was removed over an Amplatz guidewire and the tract was dilated with a 10 French dilator and a second safety guidewire was placed in the distal ureter. Over the Amplatz guidewire a 10mm balloon was placed and the nephrostomy tract was dilated with the same balloon. Following dilatatation, a 30 French sheath was placed in the renal pelvis for stone removal by Dr. X.

Right nephrostomy tract dilated with a 10mm balloon and 30 French sheath placed in the renal pelvis for nephrolithotomy by Dr. X.

We have quite a few of these charts that have all of the above procedures performed during one session. However, I am getting bundling denials. Can you give me your thoughts on how this should be coded, modifiers and all?

Thank you!
Jackie Malinowski, CPC-A